Phelan S M, Lynch B A, Blake K D, Blanch-Hartigan D, Hardeman R, Wilson P, Branda M, Finney Rutten L J
Health Care Policy and Research, Mayo Clinic Rochester MN USA.
Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Rochester MN USA.
Obes Sci Pract. 2018 Jun 14;4(4):338-346. doi: 10.1002/osp4.276. eCollection 2018 Aug.
Patient-provider communication has been found to be less patient centred, on average, with patients who are members of stigmatized or minority groups. Obesity is a stigmatized condition, and thus, people with obesity may experience less patient-centred communication (PCC). The objective of this study was to assess the association between patient body mass index (BMI) and self-reported quality of PCC experienced over a 12-month period and whether that relationship differed for men and women.
Data collected for the National Cancer Institute's Health Information National Trends Survey were analysed. Respondents who reported a BMI ≥ 18.5 kg/m and indicated having seen a healthcare provider outside of an emergency room in the last 12 months were included. PCC was measured using a validated six-item scale. Multivariate logistic regression was used to model the odds of reporting PCC greater than the sample median.
Compared with people with normal weight BMIs, no associations were found between overweight (odds ratio [OR] = 0.84, = 0.17), class I & II obesity (OR = 0.94, = 0.68) or class III obesity (OR = 0.86, = 0.47) and PCC. There was a significant interaction ( = 0.015) such that for men, but not women, higher BMI was associated with less PCC.
Unlike evidence that women experience more weight stigma, in the healthcare domain, men may be at elevated risk of experiencing communication influenced by weight stigma.
研究发现，医患沟通平均而言对被污名化群体或少数群体的患者关注较少。肥胖是一种被污名化的疾病，因此肥胖者可能体验到的以患者为中心的沟通（PCC）较少。本研究的目的是评估患者体重指数（BMI）与自我报告的12个月内PCC质量之间的关联，以及这种关系在男性和女性中是否存在差异。
对美国国立癌症研究所健康信息国家趋势调查收集的数据进行分析。纳入报告BMI≥18.5kg/m²且表示在过去12个月内曾在急诊室外看过医疗服务提供者的受访者。使用经过验证的六项量表测量PCC。采用多因素逻辑回归模型来模拟报告的PCC高于样本中位数的概率。
与体重正常的人相比，超重（比值比[OR]=0.84，P=0.17）、I级和II级肥胖（OR=0.94，P=0.68）或III级肥胖（OR=0.86，P=0.47）与PCC之间均未发现关联。存在显著的交互作用（P=0.015），即对于男性而非女性，较高的BMI与较少的PCC相关。
与女性经历更多体重污名的证据不同，在医疗领域，男性可能面临更高的受体重污名影响的沟通风险。
